Diverticulitis, IBS or Something Else

BACKGROUND:  

I have had what I thought to be multiple bouts (four) of Diverticulitis over the last couple years (CT had previously confirmed Diverticulosis).  Most of these were clinical diagnoses made by Gen Practictioners and Internal Medicines doctors.  

One previous CT showed inflammation (which was given to me as a Diverticulitis diagnosis)by the Internal Medicine doctor.

In the last month, I had an episode of pain that led to a GI specialist referral and a sigmoidoscopy.  Video showed food in the pockets, but according to the GI this is normal and no inflammation was seen.  His initial thought was IBS and I was diagnosed Zelnorm (1x day).  His read of the CT report was that it wasn't IBS (although don't know how he came up with different conclusion from same report).  He now questions the previous diagnoses of Diverticulitis.. He also seems to key in on the fact that I have occasional intestinal spasms and that pain is worse as day progresses as IBS complaints (I had always thought that riding around in a car for work all day and just the emotional wearing down of pain over the day maybe made me more sensitive).

According to several of the doctors who read my tests, I can be excluded from malnutrition, celiac, liver disfunction, giardia, food allergies (Ige test by naturopath),  bad bacteria (naturopathic test which also showed low Acidophilus levels).

I continue to have abdominal pain beneath my navel (and deep inside) and some occasional pain over my pelvic bone. Pain is fairly constant and sometimes has a feeling of tightness or pinching that worsens if abdomen is crunched forward.  Bowel movements have become darker and toothpaste-like at times as I introduce more "normal foods".  My previous BM's tended to alternate between constipation and urgent need to have a BM (which was typically fairly large (6 inches+)).  It doesn't typically hurt more when I cough.

Zelnorm has increased BM's, but otherwise has not changed pain levels and frequency.

My GI does not think another CT is warranted due to having on in the last year, but has referred me for a surgical consult (not clear on why) with a follow-up GI visit next week.

CURRENT MEDICATIONS:

Zelnorm 1x a day.

Clonazepam (for panic attacks) 0.5 MG tab 1x day.

PREVIOUS POST INFO:

I previously posted another question earlier in my treatment at this location if it helps or fills in gaps in information: http://www.medhelp.org/forums/gastro/messages/37391.html

TODAYS QUESTIONS:  

1.  Is it typical for different doctors to read a CT scan report differently (it's my understanding they read the report but did not actually look at scans)?

2.  Do any other possible avenues to test other than IBS or Diverticulitis come to mind based upon information?

3.  Is food seen in Diverticulosis "normal" without inflammation?

4.  Could an enzyme deficiency lead to bad digestion and GI distress without showing up on standard blood tests?

[Kevin Pho, MD]

To answer your questions:
1) The CT scan report is text-based and I'm not sure how several docs can read the report differently.  However, there can be different intepretations of the actual CT image.  

2) IBS is a diagnosis of exclusion - there is no specific test to rule this in or out.  The CT scan is pretty good for diverticulitis.  Contrast enema or compression ultrasound are other options for diagnosis for diverticulitis.  

3) Food seen in the setting of diverticulosis is not an uncommon scenario.

4) I am not sure what is meant by "enzyme deficiency" - I am not aware of a specific disorder that links general enzyme deficiency with the GI symptoms.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[weasel1]

I'm a 35 YO male. Forgot to Mention